Are breast cancer navigation programs cost-effective? Evidence from the Chicago Cancer Navigation Project.

摘要

There are disparities in breast cancer detection, treatment, and survival between African American, Latina, and Caucasian women. Patient navigation is a new approach to overcome access barriers that prevent disadvantaged patients from receiving appropriate and timely cancer diagnostic resolution and treatment. This study evaluates whether total costs of breast cancer patient navigation program can be off-set by survival benefits and savings in lifetime breast cancer-attributable costs for low-income ethnic minority women.;The program is a patient navigation program that aims to reduce the time interval between abnormal screening and diagnostic resolution in women who are navigated as compared to Usual Care (UC). The breast cancer component of the CCNP serves the model program for the analysis. Participants are low-income ethnic minority women 40 years and older.;Results suggest that navigating women in CCNP for abnormal mammogram screening costs on average ;In one-way sensitivity analysis of 6 key factors that may affect the ICER of navigation versus UC; the ICER is sensitive to the mean difference in the time interval between screening and diagnostic resolution in program participants compared to the UC, the percent increase in women who will ever receive cancer diagnosis and treatment because they are enrolled in the program, a woman's age, and the positive predictive value of a mammogram. The ICER is not sensitive to the number of program participants and for using total medical costs instead of breast cancer-attributable costs in calculating the ICER.;The results suggest that patient navigation for breast cancer has potential to be cost-effective. When planning patient navigation programs, the characteristics of the disease, characteristics of program participants, and characteristics of screening test should all be considered.